Category: Hair Transplantation

I have a Class 6 pattern of balding. Which is the best procedure for me? An FUE or the strip FUT?

For someone with Norwood class 6 pattern balding, the FUT (strip) technique will allow the entire job to be done in one or two sessions easily, allowing for ranges of between 2500-3500 grafts per session. A class 6 patient needs somewhere between 4,000-6,500 grafts. The wide range of transplants reflect the variations seen in the Class 6 patterns and the quality/thickness of the hair shafts. Men with fine hair, generally require more grafts but those with more confined Class 6 patterns and with medium or more coarse hair, can often get away with just one session.

The other technique, contrary to what you may read or hear, are generally limited to 1000-2000 grafts per session in the best of hands. For ideal work, you need to have a good quality of hair and enough donor density to allow for a safe surgery.

Dr. Rassman, I have a question regarding a statement you made on your Q/A blog. You said: “I wouldn’t allow any doctor to transplant into an area that has not fallen out under the excuse that there’s anticipated hair loss (behind the leading edge of your loss), as this will only accelerate the thinning. Some doctors do this, and it isn’t in your best interest, only serving to put your money in his pocket.”

I have had in-person consults with Dr. Pak in the San Jose previously. During the consult when discussing what I’d like done and the procedure itself, Dr. Pak has mentioned that he has to consider my future hairloss when he’s doing a procedure. He said he would work within my current frontal hair to add density to what I have.

So when considering what you stated in the above quote, how does that comport?

Thanks

Almost everyone we transplant has a zone between the bald area and the balding area. We allow the transplant to ‘spill’ into the balding area just in the areas that are evidently in the balding process. We never go back behind it into the area where the hair is normal and not miniaturized.

What I see often is someone with an early Norwood class 3 balding pattern who has some minimal miniaturization behind it (let’s say 25% miniaturized hairs). I might transplant hair about 1/2 – 1 cm behind the posterior bald edge, but not far into the area where there is 25% miniaturization.

Unfortunately, many doctors will transplant 1-3 inches or more behind the bald area, suggesting that it would be to prevent future balding, and it is that process that I warn about. I have recently seen a patient who needed about 800 grafts for corner balding in the frontal area, but his doctor put in 3500 grafts to prevent the balding from spreading. Not only did that cost the patient a bundle of money, but it also almost certainly damaged hair in the normal areas that got the grafts and did not need them.

Hey doc,

you mentioned in a previous post -“The Class 5A pattern does not evolve into a Class 6 or 7 pattern”. does this mean even if I am 23, norwood 4a, and I were to go for a hair transplant at my young age, I should have sufficient hair for full coverage in later years?

thanks doc!

If you are a true Norwood 4A pattern balder, then you should not progress to anything worse than a 5A pattern (not a 6 or 7 pattern). Most Norwood 5A pattern men can get a transplant to manage the entire balding pattern reasonably well. Talk to your chosen surgeon about your candidacy, as I don’t know how the density of your donor area is. At 23 years old, your final pattern may not yet be known.

Norwood 4A

Norwood 5A

Norwood 6

I’ve been looking around on internet to try to learn as much as I can about hair transplants, and I know quite a bit now, but there is one question that I can’t seem to get answered. I have a slowly receeding hairline, not very bad but definitley too much for 27 years old. I have healthy hair on the back and sides of my head but on top it’s a little thin and I think I may eventually loose it all on the top like my grandfather. I’ve tried rogaine and propecia but no dice.

My question is, would it not be a good idea to get a transplant seeing as I might lose hair behind the transplant later? Or is it possible to progressively do other transplants?

I do not believe that a Norwood class 2 pattern is worth transplanting. If you are evolving to a mature hairline, stay on Propecia and see what happens. If the hairline is actually moved up beyond the mature hairline into a class 3, you can transplant it.

I wouldn’t allow any doctor to transplant into an area that has not fallen out under the excuse that there’s anticipated hair loss (behind the leading edge of your loss), as this will only accelerate the thinning. Some doctors do this, and it isn’t in your best interest, only serving to put your money in his pocket.

I understand that you do not like the results of body hair transplants but do you think it would be an option for patients that were interested in keeping their hair cut very short and did not want the scar from FUT surgery?

Body hair transplantation (BHT) should be considered as a last resort (if you’re out of scalp donor hair, for example). It’s not just an issue of growth cycle, but the texture of body hair is different than that of scalp hair. The idea is to have the most natural looking result on your head, and I’ve yet to see anyone that has had BHT with a perfectly natural look.

If you don’t want the linear scar from traditional strip surgery, you can look into FUE, which uses scalp hair and would provide a better visual result than BHT would.